Management of genitourinary fistulas following benign gynecological and obstetric procedures: A single surgeon experience

Abstract

Background: Genitourinary fistula results in lot of anxiety in the suffering females. Scant literature regarding the comprehensive management of genitourinary fistula i.e. VVF and UVF is available. Objective: The aim of the study was to review a single surgeon experience in dealing with these complex situations. Material and Methods: We conducted a retrospective, institutional review board approved chart review of patients who underwent genitourinary fistula repair from Jan 2014 till Dec 2019. Of all the fistulas VVF accounted for 18 and UVF for 12 cases. Pre-operative diagnosis in these patients was based predominantly on the history, local examination and cystoscopy. Of the 18 VVF 12 were managed laparoscopically and 6 by open O’Connor’s repair. Of the 12 UVF, 8 were managed laparoscopically and 4 by open ureteric reimplants. All were followed up for three months post operatively. Results: A total of 30 patients were treated since 2014 till December 2019. Average age for the VVF was 54.72 ≤ 10.9 years and that for UVF repair was 59.9 ≤ 7.6 years. Hysterectomies for benign diseases accounted for 66.66% of VVF and 91.6% of UVF. Of the VVF patients one required a ureteric reimplantation, remaining were managed with O’Connors’ repair. We had one failure which was successfully repaired after 6 weeks. None of our patients with UVF repairs had a failure at three months follow- up. Conclusion: Genitourinary fistulas are a debilitating problem in females but a comprehensive approach regarding diagnosis and treatment can cure these patients.